Toothache: Why it Hurts at Night and How to Relieve It

By Jarrod Beachum, PA-C

As you may be aware by now, I tend to write my articles based on real experiences, drawing inspiration from what is happening in the moment. Well, at the time of this writing, I am having a major toothache at night, and so I wanted to write about why the tooth hurts so much at night, and how I treat it at home.

First off, what is a toothache? Every tooth has a nerve and blood supply, just like everything else in the body. When that nerve is irritated, it causes pain. Irritation can occur due to bacteria, decay, temperature changes (hot and cold), even air exposure. They tend to hurt more at night when you are going to bed because when you lay down, you get more blood flow to the head, increasing pressure in the blood vessels around the roots. This can cause increased toothaches at night. Teeth are innervated by the trigeminal nerve, which has three branches that detect sensation from the whole face and teeth. The main body sits just under the temple on both sides, and so dental pain can be much worse because once that tooth is affected, the pain can radiate throughout the other areas that the trigeminal nerves touch, leading to eye pain, intense headaches. Sometimes the pain is hard to pinpoint. As I’m writing this, I know exactly which tooth is the problem, but the radiating pain actually feels like I have a massive sinus infection mixed with a migraine and some eye pain. This can be confusing for a lot of people, and we tend to attribute our pain to the wrong cause and get the wrong treatment.

I will say the definitive treatment for dental pain is having it fixed by a dentist. There is no way to avoid this, as dental decay will not stop on its own, and uncontrolled dental infections lead to a host of complications both short-term and long-term. I absolutely recommend investing in the proper care of your teeth, but I also know that a bad toothache at 12 am is not a feasible time to see the dentist. So here is what I do to help relieve the pain.

Try swishing with warm saltwater. It may give some pain relief and clean out any debris causing irritation. I also sometimes use ice water to numb the nerve, but this takes a while and can be more painful initially. Use can use a topical oral gel or cream, such as Anbesol or Oragel, but it won’t do a lot if the pain is coming from deep within the root. What I find really helps is to take 2000-3000mg Tylenol. As long as you are otherwise healthy, that is a safe dose that will really help with the pain. Don’t wait until it is full-blown to take it either. Limit frequent use of ibuprofen and other NSAIDs, especially powders. Finally, applying something cold to the area just in front of the ear on the painful side can numb the nerve at the root, which can relieve pain in the tooth and the surrounding area too. Sit upright in a chair somewhere and wait for the pain to subside before going back to bed. It is not good to lay in bed while the toothache is still active.

Again, the best solution to dental pain is prevention, and so I recommend keeping regular appointments with your dentist, brush, and floss, and avoid sugary foods and drinks, especially at night. If you do have dental pain and can’t get into a dentist, come see us at 45 Urgent Care and we will take care of you. We also have a list of resources that those without dental insurance can go to for help.

-Jarrod Beachum, PA-C